2016 Small Group Redefinition Impacts Rating, Coverage, and Underwriting

Posted on Jun 10, 2015 in Health Care Reform, Industry & Legislative News

As employer groups with 51-100 employees renew or purchase health insurance coverage in 2016, they must abide by the rules and regulations governing the small group market, including those related to benefit coverage and essential health benefits; actuarial value, and premium rating restrictions, such as adjusted community rating and no medical underwriting.

The small group rules apply to fully insured plans, including those purchased in the Small Business Health Options Program (SHOP) marketplace.

In some markets, the state and insurance carriers may give employers the option to keep their plan for a while longer by:

  • Changing their plan year to maximize the time the employer can keep their plan in 2016.
  • Taking advantage of transitional relief, which allows employers in some states to keep their current plans through Sept. 30, 2017.

Employers that self-insure (self-funded) are not subject to these requirements.

Options and requirements vary by state, issuer and segment. For more information, please contact us for a consultation at 832-482-2494 or via email through the “contact us” page on our website.

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Why is my Insurance Company asking for my Social Security Number?

Posted on Jun 9, 2015 in Health Care Reform, Industry & Legislative News

Recently, your health insurance company may have requested your Social Security number, as well as the Social Security numbers of your spouse and your qualifying dependents. Due to a new reporting requirement, you will need to report qualifying health coverage (referred to as “minimum essential coverage”) on your yearly income tax return. This new reporting requirement will begin for the 2015 tax year, and your social security number is required by the Internal Revenue Service (IRS) for Form 1095-B. Here are some common questions you may have regarding this process.

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